Long-Term Efficacy of Methylphenidate Immediate-Release for the Treatment of Childhood ADHD.

OBJECTIVE: To evaluate the long-term effects of methylphenidate imediate-release (MPH-IR), and to confirm the efficacy established in previous meta-analyses of short-term studies. METHOD: Published and unpublished studies in which participants were treated with MPH-IR for 12 weeks or more were searched. Pooled effect sizes from these studies were computed with the DerSimonian and Laird random-effect model. Meta-regression analysis was conducted to estimate covariates associated with treatment effects. RESULTS: Seven studies were included. Pooled parents ratings for inattention and hyperactivity/impulsivity resulted in standardized mean difference (SMD) = 0.96 (95% confidence interval [CI] = [0.60, 1.32]) and SMD = 1.12 (95% CI = [0.85, 1.39]), respectively; pooled teachers ratings showed SMD = 0.98 (95% CI = [0.09, 1.86]) for inattention and SMD = 1.25 (95% CI = [0.7, 1.81]) for hyperactivity/impulsivity. No evidence of association of any covariates with treatment effect was detected in the meta-regression. CONCLUSION: MPH-IR is efficacious for childhood ADHD for periods longer than 12 weeks.

Attention-deficit/hyperactivity disorder dimensionality: the reliable 'g' and the elusive 's' dimensions.

The best structural model for attention-deficit/hyperactivity disorder (ADHD) symptoms remains a matter of debate. The objective of this study is to test the fit and factor reliability of competing models of the dimensional structure of ADHD symptoms in a sample of randomly selected and high-risk children and pre-adolescents from Brazil. Our sample comprised 2512 children aged 6-12 years from 57 schools in Brazil. The ADHD symptoms were assessed using parent report on the development and well-being assessment (DAWBA). Fit indexes from confirmatory factor analysis were used to test unidimensional, correlated, and bifactor models of ADHD, the latter including "g" ADHD and "s" symptom domain factors. Reliability of all models was measured with omega coefficients. A bifactor model with one general factor and three specific factors (inattention, hyperactivity, impulsivity) exhibited the best fit to the data, according to fit indices, as well as the most consistent factor loadings. However, based on omega reliability statistics, the specific inattention, hyperactivity, and impulsivity dimensions provided very little reliable information after accounting for the reliable general ADHD factor. Our study presents some psychometric evidence that ADHD specific ("s") factors might be unreliable after taking common ("g" factor) variance into account. These results are in accordance with the lack of longitudinal stability among subtypes, the absence of dimension-specific molecular genetic findings and non-specific effects of treatment strategies. Therefore, researchers and clinicians might most effectively rely on the "g" ADHD to characterize ADHD dimensional phenotype, based on currently available symptom items.

Economic evaluation in the field of mental health: conceptual basis.

OBJECTIVE: Technological advances in medicine have given rise to a dilemma concerning the use of new health technologies in a context of limited financial resources. In the field of psychiatry, health economic evaluation is a recent method that can assist in choosing interventions with different cost and/or effectiveness for specific populations or conditions. This article introduces clinicians to the fundamental concepts required for critical assessment of health economic evaluations. METHODS: The authors conducted a review with systematic methods to assess the essential theoretical framework of health economic evaluation and mental health in Brazil through textbooks and studies indexed in the PubMed, Cochrane Central, LILACS, NHS CRD, and REBRATS databases. A total of 334 studies were found using the specified terms (MeSH - Mental Health AND Economic, Medical) and filters (Brazil AND Humans); however, only five Brazilian economic evaluations were found. RESULTS AND CONCLUSIONS: Economic evaluation studies are growing exponentially in the medical literature. Publications focusing on health economics as applied to psychiatry are increasingly common, but Brazilian data are still very incipient. In a country where financial resources are so scarce, economic analyses are necessary to ensure better use of public resources and wider population access to effective health technologies.

Mental health economics: insights from Brazil.

BACKGROUND: As the responsibility and demand on health care grows and resources do not increase at the same pace, the healthcare system has been forced to reconsider the benefits and costs of their actions, to ensure a rational and effective decision-making process regarding the adoption of interventions and allocation of resources. Cost-effectiveness (CE) studies represent one of the basic tools to achieve this goal. AIMS: To present the current state of Health Technology Assessment (HTA) and health economics in mental health in Brazil and its importance to the decision-making process. METHODOLOGY: Descriptive paper on HTA and health economics in Brazil. Databases from government and universities as well as some scientific databases to assess the information are presented. RESULTS AND CONCLUSION: Economic analysis to evaluate interventions in mental health care is a relatively recent addition to the field of health economics; in Brazil, it is also considered a topic within Epidemiology research area. There have been an increased number of studies developed in high-income countries. However, there are fewer CE studies in low- and middle-income ones. Psychiatric disorders represent a significant burden in developing countries, where resources devoted to health care are even scarcer.

Economic evaluation in the field of mental health: conceptual basis

Objective: Technological advances in medicine have given rise to a dilemma concerning the use of new health technologies in a context of limited financial resources. In the field of psychiatry, health economic evaluation is a recent method that can assist in choosing interventions with different cost and/or effectiveness for specific populations or conditions. This article introduces clinicians to the fundamental concepts required for critical assessment of health economic evaluations. Methods: The authors conducted a review with systematic methods to assess the essential theoretical framework of health economic evaluation and mental health in Brazil through textbooks and studies indexed in the PubMed, Cochrane Central, LILACS, NHS CRD, and REBRATS databases. A total of 334 studies were found using the specified terms (MeSH - Mental Health AND Economic, Medical) and filters (Brazil AND Humans); however, only five Brazilian economic evaluations were found. Results and conclusions: Economic evaluation studies are growing exponentially in the medical literature. Publications focusing on health economics as applied to psychiatry are increasingly common, but Brazilian data are still very incipient. In a country where financial resources are so scarce, economic analyses are necessary to ensure better use of public resources and wider population access to effective health technologies. .

Switching from methylphenidate immediate release to MPH-SODAS in attention-deficit/hyperactivity disorder.

OBJECTIVE: To assess ADHD symptoms after switching from Methylphenidate Immediate-release (MPH-IR) to Methylphenidate Spheroidal Oral Drug Absorption System (MPH-SODAS) in clinically stable patients with ADHD and to identify predictors of dissatisfaction with MPH-SODAS. METHODS: This is an 8-week open clinical trial. Patients were assigned to MPH-SODAS according to their pre-study dose of MPH-IR. Assessments at baseline were conducted using the Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV), and the Barkley's Side Effect Rating Scale (SERS). Potentials predictors of treatment response were evaluated. RESULTS: From 62 patients, 47 completed the protocol. There was no significant change in the total score at the SNAP-IV (F (1,51.26) = 0.01; P = 0.91) and its subscales scores during the trial. Although no significant effect on the SERS total score (F (1,111.49) = 0.75; P = 0.39) was found, one adult patient with a previous cardiovascular condition presented a hemorrhagic cerebral vascular accident resulting in her obit. Overall, 46 (74.2%) patients reported to be satisfied. No factor assessed predicted dissatisfaction in univariated analyses. CONCLUSION: Results suggested that switching from MPH-IR to MPH-SODAS did not affect stabilization of ADHD symptoms in the majority of patients. MPH prescription in patients with previous cardiovascular conditions must be extremely careful. Further studies with long-acting MPH including larger samples and patients not responsive to MPH-IR are needed especially in countries outside the US.

[Pharmacotherapy for the treatment of anxiety disorders in children and adolescents: a sistematic review]. / Psicofármacos para o tratamento de transtornos de ansiedade em crianças e adolescentes: uma revisão sistemática.

Anxiety disorders are very prevalent in children and adolescents, causing serious impairments. The pharmacological treatment for these disorders is not much investigated in children and adolescents. Thus, there is no consensus about its indication. The present study aims to check the efficacy and tolerability of drugs used for the treatment of anxiety disorders in children and adolescents in the context of evidence based medicine. A systematic literature review was carried out in the main databases. In addition, authors were contacted. We found seven studies classified as A or B according to criteria established by the Cochrane Collaboration. Findings suggest efficacy for selective serotonin reuptake inhibitors, insignificant or unfavorable results for benzodiazepines and imipramine. Some studies present methodological problems. Methodological improvements are needed in futures clinical trials.

Psicofármacos para o tratamento de transtornos de ansiedade em crianças e adolescentes: uma revisão sistemática / Pharmacotherapy for the treatment of anxiety disorders in children and adolescents: a sistematic review

Os transtornos de ansiedade são muito prevalentes em crianças e adolescentes, causando sérios prejuízos quando não tratados. O tratamento farmacológico desses transtornos ainda é pouco pesquisado, não havendo consenso sobre sua indicação. O objetivo deste estudo é verificar a eficácia e a tolerabilidade dos psicofármacos indicados para esses transtornos em crianças e adolescentes, no contexto da medicina baseada em evidências. Foi realizada uma revisão sistemática da literatura, consultando-se as principais bases de dados disponíveis e contatando-se os autores. Foram encontrados, ao todo, sete artigos de qualidade A e B, conforme critérios da Colaboração Cochrane. Os resultados foram satisfatórios para os inibidores da recaptação da serotonina, pouco significativos ou desfavoráveis para benzodiazepínicos e imipramina. Alguns estudos apresentam problemas metodológicos. Sugere-se melhoria no planejamento de futuros ensaios clínicos.

Anxiety disorders are very prevalent in children and adolescents, causing serious impairments. The pharmacological treatment for these disorders is not much investigated in children and adolescents. Thus, there is no consensus about its indication. The present study aims to check the efficacy and tolerability of drugs used for the treatment of anxiety disorders in children and adolescents in the context of evidence based medicine. A systematic literature review was carried out in the main databases. In addition, authors were contacted. We found seven studies classified as A or B according to criteria established by the Cochrane Collaboration. Findings suggest efficacy for selective serotonin reuptake inhibitors, insignificant or unfavorable results for benzodiazepines and imipramine. Some studies present methodological problems. Methodological improvements are needed in futures clinical trials.

Consequências da evolução no conhecimento da síndrome pósðconcussional e da síndrome do estresse pósðtraumático / Consequences of the evolution of the knowledge about postconcussive syndrome and posttraumatic stress syndrome

Objetivo: Evidenciar a evolução processada no conhecimento sobre as síndromes pósðconcussionais (SPC) e do estresse pósðtraumático (SEPT) nos últimos anos e procurar identificar suas conseqüências em vários planos da atividade médica. Metodologia: Para atingir seus objetivos, os autores pesquisaram, em vários sites da web, os registros existentes entre 1990 e 2002 (12 anos), incluindo as bibliotecas da Medline, sobre o assunto. Resultados: São destacados os significativos avanços no conhecimento dessas síndromes, especialmente a partir de 1995, que apontam por imprescindíveis revisões nos conceitos do que seja psíquico e orgânico, e também no entendimento psicopatológico dessas síndromes, sua evolução nos últimos anos e as conseqüências que se abrem em face desses novos conhecimentos. Conclusão: O estudo atingiu seus objetivos por evidenciar como os novos conhecimentos trazem importantes conteúdos à prática médica no que tange ao diagnóstico, diagnóstico diferencial e tratamento, assim como para outras conseqüências psicossociais, implicadas nas perícias previdenciárias, nos planos de saúde e nas perícias judiciais

Antieméticos como indutores de ataques de pânico / Panic attack induced by antiemetic drugs

Os autores relatam dois casos de ataques de pänico induzidos por medicamentos antieméticos. Ao revisarem a literatura internacional näo encontraram achado semelhante ao lado de inúmeros medicamentos e substâncias mencionadas como panicogênicas.Igualmente, näo encontraram nas reaçöes adversas das drogas antieméticas a descriçäo da possibilidade de produçäo de sintomas dessa síndrome. Os autores realçam a importância desse achado clínico em benefício de outros pacientes que possam desenvolver tais sintomas de pânico associados aao uso de antieméticos. Discutem ainda as possibilidades fisiopatológicas para explicar a açäo panicogênica de substäncias empregadas para provocar ataques de pânico experimentalmente e de mmuitas outras capazes de promover sintomas semelhantes quando utilizadas na clínica médica

Cocaína aspectos históricos, farmacológicos e psiquiátricos / Cocaine: historical, farmacological and psychiatric aspects

Este trabalho tem como objetivo fazer uma revisäo na bibliografia sobre uso da cocaína. Abordam-se desde aspectos clínicos, físicos e psicológicos da síndrome de abstinência por cocaína, como também se faz um apanhado geral sobre a droga e seus derivados, mostrando fatores que väo desde a história e o surgimento de seu uso, mecanismo de açäo e até aspectos envolvidos no tratamento da intoxicaçäo aguda e da síndrome de abstinência